Building trust in health care systems from the ground up

Posted on Tuesday, October 26, 2021

Author: Prof. Josephine Etowa

Faculty Affiliate, ISSP
Full Professor, School of Nursing, Faculty of Health Sciences, uOttawa

On Thursday, October 14, the ISSP hosted its kickoff event for the 2021/22 academic year, Food for Thought: How has COVID affected public trust in expertise? This blog is an adaptation of the speaker’s remarks.

The development of multiple COVID-19 vaccines is an incredible achievement, but vaccinating people remains a grand challenge. In Canada, acquiring and maintaining public trust in the COVID-19 vaccine is an important part of the equation. This will require continued and focused attention, especially on populations that have been historically marginalized or face other barriers to accessing the vaccine. This includes those who are reluctant to take the vaccine because they do not feel they have enough information to make that decision. 

COVID-19 has had a profound impact on the health, social, and economic well-being of people in Canada and around the world. African, Caribbean and Black (ACB) communities represent one of the most vulnerable populations in terms of their health risk, the quality of medical care that they receive, and the chances of recovery when contracting COVID. We also know that the pattern of mortality in these vulnerable populations translate into greater challenges for health care systems through the loss of social capital, productivity, and racial and cultural equity. 

ACB Canadians and other groups disproportionately impacted by COVID also have higher levels of vaccine hesitancy. When we think about the reasons for this, healthcare experiences like the Tuskegee experiment often come to mind. In the Canadian health care system, we also hear stories of unethical treatment of marginalized groups that undermine public trust in the health care system, such as women in Nova Scotia receiving hysterectomies at the very early age without informed consent

Low health and racial literacy, historical lack of access to care, and inequities in the care that is available all help to explain why marginalized populations such as ACB communities are having these problems. More specifically, in the Black community, vaccine hesitancy in Canada is disproportionately high. Research shows that strategies that promote participatory approaches to science communications have proven effective in addressing vaccine hesitancy. Training trusted community leaders and champions to go into their communities to communicate the benefits of vaccination are essential components of an effective strategy to address vaccine hesitancy. 

Community leaders are some of the most effective messengers on the benefits of vaccination, but still, we need a multi-pronged approach. Sharing information sources, being honest about potential side-effects, providing reassurances about the robustness of the vaccine approval system, and using messages that can tell stories are all helpful pieces. We need that critical racial literacy component so that Canadians can better understand the ways in which race impacts the social determinants of health, including the co-morbidities that make ACB communities more vulnerable to serious COVID-19 infection. 

The ability of governments to communicate and successfully deliver vaccination programs is critically dependent on the extent to which they can instil and maintain public confidence in the effectiveness and safety of the vaccine, but also cultural and racial confidence in the institutions that deliver it. The principles and processes that guide government decisions and actions in vaccine procurement, distribution, prioritization and administration need to be clear to the public in order for us to actually increase confidence in the vaccine. The capacity and effectiveness of the agencies that have been handling this vaccine communication are also necessary to maintain that public confidence in the process. 

Communities have a very important role to play in building public confidence in vaccinations, but also public health more generally. Ensuring a sense of shared ownership of the process is vital. Having trusted community leaders that are part of the communication team and developing messages that are culturally appropriate are integral parts of the recipe for success. 

Groups that have historically not been treated within health care systems understandably have higher levels of distrust in the system. We need to treat them with fairness in order for them to begin to understand the system and build social cohesion and trust from the ground up. 

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